Multiple Intratesticular Cysts

Intratesticular cysts, once thought to be a rarity, are now being reported with an increasing prevalence as a result of the wider use of scrotal ultrasound scanning. Despite greater understanding of intratesticular cysts, their management remains unclear. Treatment has included enucleation and even radical orchiectomy over fear of the possibility of an associated malignancy. A more conservative approach with serial ultrasound scanning has been advocated if a clear distinction can be made between neoplastic and non-neoplastic testicular cysts. However, in view of the benign nature of such cysts, even repeated ultrasound scanning may not be necessary and may be considered over-treatment. In this study we present clinical and morphological characteristics of multiple cysts in the right testicle in a 62-year-old patient, where a slightly nodular lesion in the right testicle was detected.

Ten-year Experience of Adult Hypospadias Repairs at a Single Center / 대한비뇨기과학회지

PURPOSE: We retrospectively evaluated the results and complications of urethroplasty in adult patients with hypospadias. MATERIALS AND METHODS: Between February 1997 and June 2007, 21 adult patients with hypospadias underwent urethroplasty. The types of hypospadias were as follows: megameatus intact prepuce(MIP; n=4), subcoronal(n=5), distal penile(n=3), midshaft(n=2), penile(n=2), penoscrotal(n=2), and scrotal(n=3). Among the 21 patients, 13 were in the primary operative (group A) and 8 were in the re-operative(group B). RESULTS: The mean age of the patients was 32.4+/-6.4 years(group A, 33.1+/-6.0 years; group B, 31.1+/-7.8 years). The mean duration of catheter drainage was 8.0+/-2.4 days(group A, 7.9+/-1.8 days; group B, 8.0+/-2.1 days). The surgical procedures included tubularized incised plate urethroplasty(n=14), Thiersch-Duplay(n=3), pyramid(n=3), and transverse preputial island flap (n=1). The overall success rate was 61.9%(group A, 92.3%; group B, 12.5%). Urethrocutaneous fistulas and a meatal stricture occurred in 6 and 1 patients, respectively, with both occurring in 1 patient(38.1% overall complication rate). Fistula repairs were performed successfully in 4 patients and another fistula resolved spontaneously. The meatal strictures were treated with simple dilatation. CONCLUSIONS: Our data demonstrated a very high success rate in the treatment of primary adult hypospadias. And more careful surgical procedure is needed in patients who had history of previous failure more than 2 times because of significantly high complacation rate.

Isolated Adrenal Injury after Blunt Abdominal Trauma without Visceral Organ Injury / 대한비뇨기과학회지

Isolated adrenal gland injuries have rarely been reported, but can be potentially devastating if unrecognized. Herein, we describe a case of an isolated adrenal gland injury following a motor vehicle accident. Under the diagnosis of an isolated adrenal injury without visceral organ injury by abdominopelvic CT, conservative management led to a favorable outcome.

The Relationship of Clusterin Expression and Ki-67 Labeling Index with Clinicopathologic Factors in Human Transitional Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: This study examined the expression of clusterin and Ki-67 in human transitional cell carcinoma(TCC). In addition, the relationship of clusterin and Ki-67 expression with the clinicopathological factors and prognosis of human TCC was investigated. MATERIALS AND METHODS: 149 human TCC tissues were obtained from 149 patients who underwent a radical cystectomy(n=81) or transurethral resection(n=68). The expression of clusterin and Ki-67 was analyzed using immunohistochemical staining. The results were evaluated with respect to the clinicopathological factors. RESULTS: Positive clusterin expression was observed in 21.1% of the total TCC tissues. The expression of clusterin was not significantly related to age, gender, tumor stage and grade. However, recurrence-free survival rate of the patients with positive clusterin expression was significantly lower than that of patients with negative clusterin expression(p=0.02). The expression level of Ki-67 in the TCC tissues was associated with the tumor stage(p<0.001) and grade(p<0.001), but not with age and gender. Furthermore, the recurrence-free survival rate of patients with strong Ki-67 expression was significantly lower than that of patients with weak Ki-67 expression(p<0.001). The expression of clusterin was not significantly related to the level of Ki-67 expression. However, in the patients showing strong Ki-67 expression, the recurrence-free survival rate of the patients with positive clusterin expression was significantly lower than that of the patients with negative clusterin expression(p<0.001). CONCLUSIONS: These results suggest that the expression of clusterin and Ki-67 can be used as a useful predictor of the prognosis of patients with human TCC.

The Effect of Smoking on Penile Hemodynamics in Erectile Dysfunction / 대한남성과학회지

PURPOSE: Smoking is a known risk factor for lung cancer, cardiovascular diseases, and atherosclerosis. The link between smoking and erectile dysfunction(ED) has been supported from in vitro studies, animal studies, and epidemiological evidence. We evaluated the effect of smoking on penile hemodynamics in ED. MATERIALS AND METHODS: Patients aged 40~80 years who visited our urological institute for ED were enrolled. We performed a standard ED evaluation that included medical history, physical examination, and measurements of serum glucose, testosterone, and prolactin. We excluded ED patients with abnormal androgen profiles and patients with ED risk factors other than smoking. A total of 108 ED patients entered the study, including 51 current smokers, 24 non-smokers, and 33 ex-smokers. All patients then underwent extensive evaluation, including nocturnal penile tumescence and rigidity(NPTR) monitoring with Rigiscan(R), and pharmacopenile Doppler ultrasonography for peak systolic velocity(PSV), and end diastolic velocity(EDV). RESULTS: The average ages of the current smokers, non-smokers, and ex-smokers were 55.7+/-4.6, 53.7+/-3.9, and 56.5+/-4.3 years, respectively(p=0.07). Of current smokers, 78% had abnormal NPTR testing, compared with 64% of non-smokers and 67% of ex-smokers(p=0.04; current vs non-smokers, p=0.04; current vs ex-smokers). The average PSV for current smokers, non-smokers, and ex-smokers was 26.8+/-3.2, 31.2+/-4.5, and 29.7+/-4.4 cm/s, respectively(p=0.06; current vs non-smokers, p=0.07; current vs ex-smokers). The average EDV for current smokers, non-smokers, and ex-smokers was 5.9+/-2.7, 4.4+/-1.6, and 4.2+/-1.5 cm/s, respectively(p=0.04; current vs non-smokers, p=0.03; current vs ex-smokers). In the currently-smoking patients, there was no significant correlation between NPTR, PSV, or EDV and the amount or duration of smoking. CONCLUSIONS: We concluded that dysfunction of penile veno-occlusive mechanism plays a substantial role in the development of ED in smokers.

A Serous Papillary Cystadenoma of Borderline Malignancy in Testis / 대한남성과학회지

Serous papillary cystadenomas arising in testis have been rarely reported, and they often resemble ovarian serous tumors of borderline malignancy. Herein, we report a case of a serous papillary cystadenoma of the testis in a 59 year old man. Based on a clinical diagnosis of left testicular tumor, a left radical orchiectomy was performed. The pathologic evaluation revealed a serous papillary cystadenoma of borderline malignancy in the testis.